Cerrahi Tıp Bilimleri Bölümü Koleksiyonu

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https://hdl.handle.net/20.500.12428/2266

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What is the mechanism of action of anticholinergics in the bladder – is it neurogenic or non-neurogenic?
(Ali İhsan TAŞÇI, 2014) Abdulmajed, Mohamed; Reşorlu, Berkan; Gülpınar, Murat Tolga
The human urinary bladder is a highly – compliant storage device and nerve supply to the bladder is relatively complex. Dysfunction of the nervous system could affect the urinary bladder negatively, a condition called ‘neurogenic bladder’. Among neurogenic bladder complications, urinary incontinence is the most significant factor in determining quality of life. Urinary incontinence in neurogenic bladder is explained by detrusor overactivity on urodynamic assessment. Oral anticholinergic medications are largely accepted as the cornerstone in the management of neurogenic detrusor overactivity. In this review article, we closely analyse the mechanism by which anticholinergic treatment help increasing bladder compliance and bladder capacity and reducec involuntary detrusor contraction in neurogenic bladder cases [TR] İnsan mesanesi, kompliansı yüksek, sinirsel desteği ise oldukça kompleks yapıda bir depolama organıdır. Bu bölgeyi innerve eden sinir sisteminin disfonksiyonu nörojen mesane olarak adlandırılmakta ve mesane fonksiyonlarını değişen derecelerde etkileyebilmektedir. Nörojen mesaneye bağlı oluşan semptomlar içerisinde yaşam kalitesini en çok etkileyeni idrar inkontinansı olarak bildirilmektedir. Nörojen mesanede idrar inkontinansı oluşumunun en önemli mekanizmlarından birisi ürodinamik çalışmada detrüsör aşırı aktivitesi ile izah edilmektedir. Oral antikolinerjik ilaçlar nörojen detrüsör aşırı aktivitesinin tedavisinde dönüm noktası olarak kabul edilirler. Bu derlemede nörojen mesane olgularında mesane kompliansını ve kapasitesini arttırmak ve istemsiz detrüsör kontraksiyonlarını azaltmak için kullanılan antikolinerjik tedavinin etki mekanizmasını analiz ettik
EVALUATION OF THE SIMPLE HEMATOLOGIC MARKERS IN PATIENTS WITH GESTATIONAL DIABETES MELLITUS: A CASE-CONTROL STUDY
(Yozgat Bozok University, 2021) Pek, Eren; Beyazıt, Fatma
Objective: Gestational diabetes mellitus (GDM) is defined as various degrees of glucose intolerance that begins or is first detected during second or third trimester of pregnancy. In order to prevent serious mater nal and/or neonatal outcomes, early diagnosis and adequate treatment strategies are of great importance. Simple hematologic parameters such as mean platelet volume (MPV), red cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) have increasingly been repor ted as measures of presence and severity of GDM. This study aimed to determine whether there is an association between these parameters and the presence of GDM Material and Methods: A total of 78 GDM patients and 89 age- and gestational-age-matched pregnant controls were studied. MPV, RDW, NLR and PLR values in all patients were calculated and recorded from complete blood cell counts. Results: For GDM patients, the mean MPV, NLR, PLR and RDW values were 8.8±1.0, 3.8±2.3, 120.6±42.9, and 15.3±2.6 respectively; for healthy pregnant controls, the values were 8.6±0.8, 3.5±2.1, 130.6±40.8, and 14.1±1.8 respectively. Although only MPV and RDW levels of GDM patients were significantly higher compared with healthy controls, no statistically significant difference was found between both study groups in respect to PLR and NLR. Conclusion: Mean platelet volume and RDW but not NLR and PLR, which are automatically calculated from complete blood count parameters plays important predictive roles in GDM.
Comparison of Bicortical Headless Cannulated Screw Fixations, Tension Band Fixations, and Kirschner Wire Fixations of a Jones Fracture A Biomechanical Study
(Amer Podiatric Med Assoc, 2024) Yılmaz, Onur; Mutlu, İbrahim; Kuru, Tolgahan; Bilge, Ali; Güngör, Berna; Kızılay, Hasan; Olcar, Hacı; Erken, Hüseyin Yener
Background: The aim of study was to biomechanically compare the fixation of Jones fracture using headless cannulated screw, tension band, and two Kirschner wires.' Methods: A total of 60 fourth-generation, fifth metatarsal synthetic bone models were divided into three groups according to the fixation techniques. A vertical load, oriented from plantar to dorsal and lateral to medial, was applied to the metatarsal specimen that were potted with molding material. The stiffness and fatigue values were compared between the three fixation groups. Results: In the plantar to dorsal load test, the stiffness values were found to be significantly higher in Group 1 compared to the other groups (P = .034, P = .013). No significant difference was found in the analysis in terms of fatigue values in plantar to dorsal load testing (P = .348, P = .416). No significant difference was found between compression screw and tension band groups in lateral to medial loading test, in terms of stiffness and fatigue values (P = .096, P = .762). However, the stiffness values and fatigue values of these two groups were found to be statistically significantly higher than the Kirschner wire group (P = .003, P = .002, P = .016, P = .023). Conclusions: The result of this study showed that the bicortical fixation of headless compression screw provides a more stable fixation than other fixation methods, especially in plantar to dorsal loading. (J Am Podiatr Med Assoc 114(6), 2024; doi:10.7547/22-201)
Re: Akyurek M et al. Influence of palmar plate injury on outcomes of zone 2 flexor tendon repair. J Hand Surg Eur. 2024, doi:10.1177/17531934241300510 Reply
(Sage Publications Ltd, 2025) Akyürek, Mustafa; Hafız, Güneş; Sayan, Mihrican
[No abstract available]
Moxifloxacin-Impregnated Contact Lenses for Treatment of Keratitis in Rabbit Eyes
(Wiley, 2025) Erdoğan, Hakika; Güngör, Buket; Sağbaş Suner, Selin; Sılan, Coşkun; Saraydın, Serpil U.; Saraydın, Dursun; Ayyala, Ramesh S.; Şahiner, Nurettin
Moxifloxacin (MOX) was loaded into commercial contact lenses (CLs) via supercritical carbon dioxide (ScCO2) to attain MOX-impregnated CL for keratitis treatment. This study aimed to investigate Pseudomonas keratitis treatment with MOX-impregnated CL compared to the traditional eyedrop administration. MOX impregnation was accomplished employing optimum parameters of 2.5 h drug exposure time, 25 MPa pressure, and 313 K for ScCO2 conditions using ethanol co-solvent rendering sustainable delivery, up to 7 days at effective dosage formulation. The MOX-impregnated CL was found to be safe with no significant toxicity on fibroblast cells after 5 days of contact time. Bacterial viability in vivo keratitis treatment in rabbit eyes was significantly decreased to 10(2) from 10(9) CFU/cornea for MOX-impregnated CL treatment, almost similar to exhaustive conventional 0.5% MOX eye drop treatments. The MOX-impregnated CL treatment revealed no conjunctival hyperemia, edema, or secretion for all eyes in the relevant group, and transparent cornea with no keratitis focus was obtained for two of the eyes (n = 6). The normal histological structure was seen with MOX-impregnated CL treatment on healthy eyes. Moreover, polymorphonuclear cell infiltration observed in keratitis eyes without any treatment was significantly decreased to a few polymorphonuclear cells in the groups treated with MOX eyedrops and MOX-impregnated CL.
Investigation of Human Hair by Laser-Induced Breakdown Spectroscopy: Qualitative and Quantitative Analysis of Content Element in Human Hair
(Wiley, 2025) Arbi, Ines; Yümün, Gündüz; Sezgin, Nursel
Human hair is a significant biological sample in forensic science, biomedical research, and the cosmetic industry, with the presence of essential nutrients like zinc, copper, and silicon being indicative of health. This study aimed to investigate the elemental composition of human hair using Laser-Induced Breakdown Spectroscopy (LIBS) to assess differences across age groups. Nine volunteers provided hair samples, which were analyzed using the Foster + Freeman ECCO2 LIBS system. Quantitative analysis of elemental concentrations was performed, and elemental ratios, such as Mg/Ca, Mg/Si, Mg/Fe, and Fe/Mn, were calculated to compare the samples. Results demonstrated that LIBS is a fast, accurate, and non-destructive method for detecting and quantifying mineral elements in human hair. The study highlights age-related differences in elemental concentrations, offering insights into the use of hair analysis for monitoring nutritional and health status. LIBS could be a promising tool for further studies in clinical and forensic applications.
Virgin ureter vs. non-virgin ureter? A comparative analysis on complications and failure of retrograde intrarenal surgery: a multicentre case-control study from RIRSearch Group
(Springer, 2025) Teke, Kerem; Çınar, Naci Burak; Çınar, Önder; Akgül, Murat; Başataç, Cem; Şimşekoğlu, Muhammet Fatih; Çakır, Hakan; Sıddıkoğlu, Duygu; Sancak, Eyüp Burak
It is unclear whether ureteral virginity has an effect on retrograde intrarenal surgery (RIRS). We aimed to evaluate the impact of ureteral virginity on RIRS outcomes in a multicenter study. Data from the RIRSearch study group database were retrospectively reviewed. Patients with a history of endoluminal interventions or extrinsic ureteral surgery were categorized as having a non-virgin ureter, while those without such histories were classified as virgin ureters. Case-control matching was performed based on age, gender, uretral access sheath size, and stone characteristics. Demographic, clinical, surgical and complication data were compared after-matching. A total of 894 procedures were included, with 119 (13.3%) involving non-virgin ureters. Pre-matching, the non-virgin ureter group had higher mean age (50.6 +/- 13.2 vs. 46.6 +/- 13.6 years) and Charlson comorbidity index >= 2 (51.3% vs. 40.4%). In addition, number of stones, total-stone volume and rate of multiple stone localization were significantly higher in non-virgin ureter group. Operation time, hospital stay, surgical failure, need for auxiliary treatment, and perioperative complications were significantly higher in non-virgin ureter group (p < 0.05). After case-matching, perioperative complications (18.7% vs. 5.3%), hospital stay (1.54 +/- 1.30 vs. 1.18 +/- 0.98 days), and auxiliary treatment requirements (20% vs. 8.4%) remained significantly higher in non-virgin ureter group (p < 0.05). There was no significant difference in postoperative complication rates (17.3% vs. 19.8%) or surgical failure rates (36% vs. 26%). Non-virgin ureters were associated with higher perioperative complication rate, longer hospital stays and increased need for auxiliary treatments during RIRS. Patients with non-virgin ureters may be informed about these potential risks before surgery.
Intracameral medications in cataract surgery
(Springer, 2025) Bektaş, Çağlar; Yüksel, Erdem
PurposeTo review the indications, dosages, and safety profiles of intracameral drugs used during cataract surgery.MethodsA narrative review was conducted, evaluating published clinical studies, review articles, and guidelines related to intracameral drug use in cataract surgery. The analysis focused on drugs commonly used for anesthesia, mydriasis, inflammation control, and intraoperative complication management. Special consideration was given to their utility in high-risk surgical scenarios, such as small pupils, intraoperative floppy iris syndrome, white or pediatric cataracts, and cases with zonular weakness.ResultsIntracameral drugs have proven beneficial in achieving effective anesthesia, maintaining pupil dilation, and controlling inflammation during cataract surgery. Their use is particularly advantageous in complex cases, including those with corneal opacity, posterior capsular rupture, or combined procedures like minimally invasive glaucoma surgery and premium IOL implantation. When prepared and administered properly, these agents contribute to safer and more efficient surgeries. However, improper preparation or dosing can lead to ocular toxicity, highlighting the importance of meticulous handling.ConclusionIntracameral drug administration is a valuable adjunct in cataract surgery, enabling surgeons to manage routine and complex cases more effectively. Understanding their appropriate use and potential risks is essential to maximize patient safety and surgical success.
Bariatric Surgery and Remission of Metabolic Syndrome: A Meta-analysis of Randomised Controlled Trials and Prospective Studies
(Springer, 2025) Dean, Yomna E.; Mohamed, Mohamed I.; Shokri, Abdulrahman; Nassar, Moussa; Omayer, Abu; Shahid, Maryam; Sharif, Arsalan; Güvem, Asım Eren
Background Studies have discussed the efficacy of bariatric surgery (BS) in remission of individual components of metabolic syndrome (MS). We aimed to analyse the prevalence of MS following BS. Methods On October 5, 2023, we conducted a literature search on PubMed, Scopus, Web of Science, and Cochrane. RevManv5.4 was used for the analysis. Results MS patients who underwent BS had lower odds of MS within the first year post-BS (OR 0.14, 95%CI 0.12-0.17); patients who had a preoperative BMI < 50 showed a higher reduction in MS post-BS compared with patients who suffered from super obesity (OR 0.12 versus OR 0.17). Older patients (age > 42) had lower odds of MS post-BS compared with younger patients (OR 0.05 versus OR 0.17). There was not a difference in MS prevalence between 1 and 2 years postoperatively (OR 1.07, 95%CI 0.72-1.58). Asians reported the highest reduction in MS post-BS (OR 0.08). MS patients who received medical treatment had three times the odds of having MS compared with patients who underwent BS. Patients who had BS reported a decline in their anti-hypertensives and oral anti-diabetic drugs (OR 0.26, 95%CI 0.15-0.46, OR 0.11, 95%CI 0.07-0.16, respectively). There was not a significant difference in MS prevalence between patients who underwent RYGB and those who had SG (OR 2.16, 95%CI 0.74-6.26). Conclusions BS is superior to medical treatment in the remission of MS. Age, preoperative BMI, and country of origin affect the rates of MS remission. BS results in a sustainable resolution of MS across 1, 2, and 5 years post-surgery. A tailored approach is warranted to achieve the best outcomes.
Does the 5-Item Modified Frailty Index Predict Adverse Outcomes after Retrograde Intrarenal Surgery? A Case-Control Study by the RIRSearch Group
(Mary Ann Liebert, Inc, 2025) Başataç, Cem; Şimşekoğlu, Muhammed Fatih; Teke, Kerem; Tuna, Mustafa Bilal; Çınar, Önder; Akgül, Hacı Murat; Özman, Oktay; Sıddıkoğlu, Duygu; Sancak, Eyüp Burak
Objectives: We aim to assess whether severely frail patients have an increased risk of complications and worse surgical outcomes after retrograde intrarenal surgery. Methods: The data of 340 consecutive patients undergoing retrograde intrarenal surgery to treat upper tract urinary stones were analyzed retrospectively. The 5-item modified frailty index (mFI-5) was used to assess the frailty status. Using a cutoff value of score 2 in the mFI-5 score, patients were divided into two groups: patients with an mFI-5 score <2 were assigned to a non-frail (Group 1) group, and patients with an mFI-5 score >= 2 were assigned to a frail (Group 2) group. The patients' demographics, stone characteristics, operative outcomes, and complication rates were compared between the groups. The primary objective was to examine whether the surgical outcomes were much better in non-frail patients. Results: After matching confounding factors, Group 1 comprised 255 patients, and Group 2 comprised 85 patients. The baseline characteristics were similar between the groups. There were no statistically significant differences in terms of the median operation time and length of hospital stay among groups. There were no significant differences between groups for intraoperative complication rates (7.6% and 9.4%, respectively; P = .47) and postoperative complication rates (13.8% and 11.8%, respectively; P = .71), and stone-free rates (70.9% versus 72.9%, respectively; P = .73). Conclusions: Retrograde intrarenal surgery is an efficient and feasible treatment option for upper urinary tract stones in severely frail patients.
Idiopathic Granulomatous Mastitis: A Consensus Report on Treatment and Follow-Up Approaches Based on the Turkish Clinical Classification
(Karger, 2025) Emiroğlu, Mustafa; Çetin, Kenan; Yılmaz, Kerim Bora; Velidedeoğlu, Mehmet; Girgin, Sadullah; Akcan, Alper; Aytaç, Özgür
Objective: The second consensus study on idiopathic granulomatous mastitis (IGM) aimed to establish treatment options based on the clinical classification proposed in the first consensus, standardize criteria for treatment discontinuation, and develop follow-up protocols. Method: A structured methodology, identical to the first consensus study, was employed. An 11-member working group of breast surgeons experienced in IGM from various clinics across the country was formed. The modified Delphi method was used, with a consensus threshold of 80% agreement. Results: Three voting rounds were conducted to develop the IGM treatment algorithm. In Round 1, observation was established as the first-line option for Type 1 disease (81%) and pregnancy/lactation cases (85%). Round 2 achieved consensus on systemic steroids (SS) as the first-line treatment for Type 3 cases (84%), combination therapies for resistant cases (82%), and reclassification of recurrent cases to guide treatment planning (94%). In Round 3, consensus was reached on the use of immunosuppressive therapy (IMT) for cases where steroids are contraindicated in Type 3 (81%), the use of IMT for resistant cases (93%), avoiding surgery as the first-line option for Type 1 cases (81%), and requiring complete clinical and radiological response before discontinuing treatment (81%). However, no consensus was reached on the first-line treatment for Type 2 disease. Conclusion: This consensus study successfully developed a treatment algorithm for IGM, prioritizing observation for Type 1 disease and cases involving pregnancy or lactation, and recommending systemic steroids (SS) and immunosuppressive therapies for Type 3 cases. The findings underscore the critical importance of achieving complete clinical and radiological remission before discontinuing treatment. However, the lack of consensus on the treatment of Type 2 disease highlights the need for further research into this challenging subtype.
SCOLICIDAL POTENCY OF BILE AGAINST ECHINOCOCCUS GRANULOSUS
(Knowledgeworks Global Ltd-Kgl, 2025) Aydın, İsa Caner; İlhan, Noyan; Şeker, Ahmet; Ofluoğlu, Cem Batuhan; Mulkut, Fırat; Göret, Nuri Emrah; Çetin, Kenan
Cysto-biliary fistulas are commonly diagnosed, either before or after surgical intervention, in patients with enlarged or advanced-stage hydatid cysts (HCs). Analysis of cystic contents in these patients shows that diminished scolex vitality is more common in patients with cysto-biliary fistulas. This study aims to demonstrate the scolicidal effects of bile on Echinococcus granulosus (EG) scolices at various bile concentrations and over specific periods. The time- and concentration-based scolicidal potency was analyzed in EG scolex samples obtained from HC patients. The integrity of the cyst wall and the scolicidal effect of the contents were evaluated using a vital staining technique with 0.1% eosin. Bile samples were collected from patients with cholelithiasis who were scheduled for surgery. Scolicidal efficacy of 100% was observed in all samples at the 1/4 bile concentration after 10 min and at the 1/8 concentration after 60 min. At a 1/16 concentration, scolicidal efficacy was 66% at 1 min, 89% at 10 min, 93% at 30 min, and 98% at 60 min. At a 1/32 bile concentration, scolicidal efficacy was 59% at 1 min, 68% at 10 min, 89% at 30 min, and 95% t 60 min. At a 1/64 concentration, the scolicidal efficacy was 53% at 1 min, 58% at 10 min, 77% at 30 min, and 93% at 60 min. After 1 hr, reasonable scolicidal efficacy was determined up to a 1/64 concentration; however, significant decreases in scolicidal efficacy were observed at 1/128 and 1/256 bile concentrations. Theoretically, bile, which is an endogenous secretion, can be used as a suitable and potent scolicidal agent. This study lays the groundwork for future in vivo clinical trials utilizing synthetic bile acids for scolicidal purposes or for studies evaluating the scolicidal effects of bile in patients who develop cysto-biliary fistulas.
Advancing ICU mortality prediction in community-acquired pneumonia: Combining fibrinogen-to-albumin ratio, CT severity score, PSI, and CURB-65
(Assoc Basic Medical Sci Federation Bosnia & Herzegovina Sarajevo, 2025) Ünal Çetin, Ece; Kurtkulağı, Özge; Kamış, Fatih; Daş, Murat; Şimşek, Esen; Çetin, Adil Uğur; Beyazit, Yavuz
Community-acquired pneumonia (CAP) is a leading cause of ICU admissions, with significant morbidity and mortality. Traditional risk stratification tools such as CURB-65, the Pneumonia Severity Index (PSI), and CT severity scores (CT-SS) are widely used for prognosis but could be improved by incorporating novel biomarkers. This retrospective study evaluated the fibrinogen-to-albumin ratio (FAR) as an additional predictor of 30-day mortality in ICU patients with CAP. A total of 158 CAP patients admitted to a tertiary care ICU were included. Baseline data encompassed demographic, clinical, laboratory, and radiological parameters, including FAR, CURB-65, PSI, and CT-SS. Logistic regression and ROC curve analyses were conducted to assess mortality predictors. The 30-day mortality rate was 70.88% (112/158). Higher FAR, PSI, CURB-65, CT-SS, and lactate levels were independently associated with increased mortality (p < 0.05). FAR demonstrated strong discriminatory power (AUROC: 0.704) and significantly improved the predictive accuracy of established models. Adding FAR to PSI increased the area under the receiver operating characteristic (AUROC) from 0.705 to 0.791 (p = 0.009), while combining FAR, CT-SS, and PSI yielded the highest predictive accuracy (AUROC: 0.844, p = 0.032). These findings suggest that FAR, which reflects both inflammation and nutritional status, complements traditional risk assessment tools by providing a dynamic perspective. Integrating FAR into existing models enhances the identification of high-risk patients, enabling timely interventions and more efficient resource allocation in the ICU.
Ultrasound-guided serratus posterior superior intercostal plane block for unilateral dorsal thoracic myofascial pain
(Edizioni Minerva Medica, 2025) Sayan, Mihrican; Sayan, Ozan; Erbaş, Mesut
[No abstract available]
The Effect of Full and Empty Bladders on Uterine Artery Doppler Parameters in the First Trimester
(Imr Press, 2025) Duran, Mehmet Nuri; Sarıdaş Demir, Süreyya; Demirkaya, Lokman Semih; Ilgin, Serem Kel; Pek, İbrahim Eren; Demir, Bülent
Background: The presence of increased resistance in uterine artery Doppler measurements is associated with preeclampsia and other adverse pregnancy outcomes. Therefore, this study aimed to evaluate whether a full or empty bladder affects uterine artery Doppler results. Methods: This study included 213 women with singleton pregnancies between 11-13 weeks. The first measurement for bilateral uterine artery Doppler parameters was performed while the patients experienced a full bladder, while the second measurement was conducted immediately following urination. Results: Uterine artery notching presented statistically significant results when the bladder was evaluated as full and empty. While the mean values calculated for the left uterine artery pulsatility index were 1.82 +/- 0.04 before micturition, this value was calculated as 1.74 +/- 0.04 after micturition (p = 0.011). The mean value for the right uterine artery while the mean value was 1.85 +/- 0.042 before micturition, it was calculated as 1.81 +/- 0.041 after micturition (p < 0.001). Uterine artery resistance indices were also statistically different before and after micturition. The mean values calculated for the left uterine artery resistance index were 0.77 +/- 0.008 before micturition and 0.74 +/- 0.007 after micturition (p = 0.003). For the right uterine artery, it was calculated as 0.76 +/- 0.008 before micturition and 0.75 +/- 0.01 after micturition (p = 0.047). Conclusions: Although there are minimal studies on this subject in the literature are limited, physiological principles and the results of the present study show that emptying the bladder before arterial Doppler evaluation of spaces such as the abdominal compartment, will provide more accurate results.
Biomechanical Comparison of Single- and Double-Twist Tension Band, Cancellous Screw, and Single-Screw Tension Band Models in Medial Malleolus Fractures
(Amer Podiatric Med Assoc, 2025) Nusran, Gürdal; Yılmaz, Onur; Mutlu, İbrahim; Kuru, Tolgahan; Erken, H. Yener
Background: Models using a double-twist tension band, two partially threaded cancellous screws, a single-twist tension band, and a single-screw tension band were biomechanically compared for fixation of medial malleolus fractures. Methods: All 72 composite cortical tibial bones used in the study were osteotomy suitable for medial malleolus fracture. They were divided into four groups: double-twist tension band (group 1), two partially threaded cancellous screws (group 2), single-twist tension band (group 3), and single-screw tension band (group 4), with 18 composite tibial bones in each group. Bones in each group were divided into three subgroups and subjected to biomechanical tests by applying force as tension, transverse, and axial loading. Results: In the tension and transverse loading tests, the highest mean stiffness was in groups 1 and 4. Group 4 had statistically significantly higher stiffness values than groups 2 and 3. All of the other groups had statistically significantly higher stiffness values than group 2. A statistically significant difference was found comparing group 4 (with the highest value in the axial loading test) with the other groups. No significant difference was found between groups 1 and 3 in any of the biomechanical tests. Conclusions: Tension band method did not make a difference biomechanically when applied as a double or single twist. Single-screw tension band was found to be the most stable fixation method in tension, transverse, and axial loading tests. We think that the single-screw tension band method is a stable and suitable fixation method and should find more place in current surgical practices.
The effects of systemic ozone application and hyperbaric oxygen therapy on avascular necrosis of the femoral head: An experimental study in the vascular deprivation of the rat femoral head model
(Turkish Joint Diseases Foundation, 2025) Yılmaz, Onur; Erken, Hüseyin Yener; İçkin Gülen, Meltem; Güven Bağla, Aysel; Adalı, Yasemen; Kuru, Tolgahan
Objectives: This study aims to assess the effects of systemic medical ozone (O3) application and to compare its effects with hyperbaric oxygen (HBO) therapy for preventing avascular necrosis of the femoral head in a rat model. Materials and methods: A total of 50 male Wistar albino rats were divided into six groups including five rats in each control and sham-operated control group and 10 rats in the remaining four groups: (i) control group, (ii) sham-operated control group, (iii) avascular necrosis group, (iv) intraperitoneal ozone given avascular necrosis group, (v) HBO therapy given avascular necrosis group, and (vi) intraperitoneal ozone and HBO given avascular necrosis group. We surgically induced osteonecrosis by cutting the ligamentum teres and placing a tight ligature around the femoral neck. At Week 11, we harvested femoral heads bilaterally from each animal and performed a macroscopic, histological evaluation and histomorphometric, immunohistochemical analysis. Results: The intertrabecular mesenchymal cell ratio was substantially higher in the O3 group than that of all other groups in the histological evaluation (p<0.05). Group O3 had also significantly more CD31-positive stained new vasculature than other groups, with the exception of the HBO therapy group, according to the immunohistochemical analysis (p<0.05). Conclusion: The results of this experimental study suggest that the application of medical ozone alone may have a positive effect on new vessel formation and the repair process and may be more beneficial than HBO therapy and HBO+O3 therapy in the vascular deprivation of the rat femoral head model. © 2025 All right reserved by the Turkish Joint Diseases Foundation
Predicting New-Onset Atrial Fibrillation in Patients with Coronary Artery Bypass Graft: the Precise-Dapt Score
(National Scientific Medical Center, 2024) Küçük, Uğur; Şahin, Serpil
Aim: Postoperative new-onset atrial fibrillation (POAF) after isolated coronary artery bypass graft surgery (CABG) is associated with adverse events. The Predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score is used to predict the bleeding risk after dual antiplatelet therapy and has been associated with arrhythmias in recent years. Therefore, the present study sought to investigate the association between the PRECISE-DAPT score and POAF after coronary artery bypass graft surgery. Materials and methods: 350 patients who underwent CABG were retrospectively screened. After exclusion criteria, 135 patients were included in the study. A total of 135 patients who underwent on-pump CABG were divided into two groups: patients with POAF and those without POAF. The PRECISE-DAPT score was calculated for each patient, and intergroup comparisons of the calculated scores were performed. Results: POAF was detected in 66 patients out of 135. Patients with POAF had longer hospital stays. PRECISE-DAPT score was higher in the patients with POAF compared to the patients without POAF (p<0.001). PRECISE-DAPT score was determined to be a predictor of POAF after CABG (odds ratio [OR]: 1.305; 95% confidence interval [CI]: 1.268–2.030; p<0.001). The PRECISE-DAPT score for POAF risk had a sensitivity of 60% and a specificity of 79% at cut-off values of 14.5 and above. Conclusion: An increased PRECISE-DAPT score may be used as a predictive score for POAF that may develop during hospital stay after on-pump CABG. © 2024, National Scientific Medical Center. All rights reserved.
Evaluating Auricular Conchal Cartilage Grafts in the Surgical Management of Pediatric Orbital Floor Fractures
(Lippincott Williams and Wilkins, 2025) Akyürek, Mustafa; Battal, Buruç Barkın; Hafiz, Güneş
Pediatric orbital floor fractures present unique challenges due to ongoing craniofacial growth and the need for reconstructive materials that provide stability while minimizing long-term complications. This retrospective study evaluates the outcomes of auricular conchal cartilage grafts in the surgical management of pediatric blowout fractures. Pediatric patients aged 7 to 16 years who underwent orbital floor reconstruction with conchal cartilage grafts between October 2013 and September 2023 were analyzed. Clinical data, computed tomography findings, surgical details, and postoperative outcomes were reviewed. Among 31 patients diagnosed with blowout fractures, 8 underwent surgical repair using conchal cartilage grafts. The mean age of surgically treated patients was 11.8 years, with an approximate orbital defect size of 2.8 cm2. The mean follow-up period was 25 months. No postoperative infections or donor site deformities were observed. In long-term follow-up, 1 patient exhibited both diplopia on inferolateral gaze and enophthalmos. The use of auricular conchal cartilage provided a structurally compatible, low-morbidity alternative to traditional graft materials. Its inherent concave shape and ease of harvest make it a viable option for pediatric orbital floor reconstruction. The findings of this study support the use of conchal cartilage as a reliable autologous graft for orbital floor repair in pediatric patients; however, further studies with larger patient cohorts and comparative analyses are required to better define its long-term outcomes and optimal indications. Copyright © 2025 by Mutaz B. Habal, MD.
Modified Dermal-Fat Flap Suspension Technique for Internal Nasal Valve Dysfunction: A Comparative Study With Conventional Cartilage Grafting
(Lippincott Williams and Wilkins, 2025) Akyürek, Mustafa; Çakır, Bahadır; Hafız, Güneş; Tavas, Ozan
Iatrogenic internal nasal valve (INV) dysfunction is a significant complication after nasal surgery, often necessitating revision surgeries involving cartilage grafting, which carries high risks of complications such as mucosal synechiae, septal perforations, and chronic inflammation. This study evaluates the efficacy of a modified dermal-fat flap suspension technique as an alternative to conventional cartilage grafting for INV reconstruction. A retrospective review was conducted of 30 patients treated between March 2019 and March 2023, including 8 patients who underwent the modified dermal suspension technique and 22 who received spreader grafts. Preoperative and postoperative nasal obstruction symptom evaluation scores were statistically analyzed using the Mann-Whitney U test. While both groups demonstrated significant postoperative improvements, no statistically significant differences were found between the groups. The modified technique, performed under local anesthesia, was associated with fewer complications and avoided extensive cartilage grafting or mucosal dissection, making it particularly suitable for patients with advanced age, high ASA scores, or complex surgical histories. Common complications included transient orbital edema and rare cases of skin discoloration, which resolved over time. Despite a small sample size and reliance on subjective nasal obstruction symptom evaluation scores, this study highlights the potential of the modified dermal-fat flap suspension technique as a less invasive, effective alternative for managing INV dysfunction, especially in high-risk patients. Further studies with larger cohorts and objective measures are needed to validate these findings. Copyright © 2025 by Mutaz B. Habal, MD.

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